Utilización de injertos hepáticos de donantes octogenarios en trasplante hepático: análisis comparativo con injertos de donantes menores de 65 años

Abstract

El trasplante de hígado (TH) es el procedimiento universalmente aceptado para los pacientes que padecen una patología crónica o aguda hepática que amenaza la vida, hepatocarcinoma y varias enfermedades metabólicas. Los buenos resultados obtenidos a lo largo de los años con TH han llevado a un aumento del número de candidatos en la lista de espera, mientras que el número de injertos hepáticos no es suficiente para atender a todos los pacientes que necesitan un TH. En consecuencia, la escasez de los injertos hepáticos se asocia con una aumento de la mortalidad en lista de espera de los candidatos, en España se produjo un 4,6% durante el 2014 con una actividad global de 1,068 LT. Por lo tanto, la principal limitación para el LT está siendo el tener acceso a un injerto hepático...Liver transplantation (LT) is the universally accepted procedure for patients who suffer life-threatening chronic and acute liver disease, hepatocarcinoma and several metabolic diseases. The good results obtained along the years with LT have led to an increasing number of candidates on the waiting list, while the number of liver grafts is not enough to attend all patients who need a LT. Consequently, the shortage of liver grafts is associated with waiting list mortality of candidates, referred in Spain as 4.6% during the 2014 with an overall activity of 1068 LT (Liver Donor Registry-ONT-2014). Thus, the main limitation for LT is having access to a liver graft. With the intention to resolve the graft liver shortage the LT teams have proposed to expand the donor pool using so-called marginal donors or extendedcriteria donors, a not well-defined group in which are mainly included donors > 60 years, history of malignancies, donors with hypernatremia, prolonged intensive care unit (ICU) stay, vasoactive drug requirements steatosis, positive serologies for hepatitis C or B virus, livers with a cold ischemia time > 12 hours, non-heart beating donors, and grafts from split-liver and living-related donations (Strasberg, 1994; Adam, 1995; Ureña, 1998; Lopez-Navidad, 2003; Busuttil, 2003; Yersiz, 2003; Renz, 2005). The donor population in Spain has progressively aging in the last 15 years (12.4% of donors were septuagenarians in 2000 versus 30% in 2014). At the same time, cerebrovascular accident as the main cause of donor death has also increased (from 56.4% in 2000 to 65.5% in 2014) (Liver Donor Registry-ONT-2014)...